Generally, this invention relates to a computer-based system for transcription and related information and other security and data intensive information or the like. Specifically, the invention may focus on applications, methods, software, hardware, services, and even business methods which can provide a variety of functions important in transcribing or handling information, such as medical information, including but not limited to convenient transcription with menu data tailoring as may be of interest to some of the users of the particular information involved. It may involve handling the information through a network such as the global information network or Internet. Specifically, the invention focuses on applications, methods, software, hardware, services, and even business methods which can provide a variety of functions important in the handling of the information, including but not limited to access, research, and other such functions. It can provide a variety of functions important in the dealing with the information, including but not limited to encoding such information with details of interest to some of the users of such information.
One of the more inefficient environments in which to capture data is that from verbal information. Because verbal or perhaps dictated information can use a variety of words or phrases for a singular meaning and because verbal information can be highly originator dependent, it can be challenging to capture in a structured data format. But one example is that of the medical environment. This environment can present not only one for which the need can be acute (such as to help the patient with a potentially fatal complication) but also one in which the structures and formats can range from one of insurance billing to one of a need for immediate correlation of information. This is compounded by the professional not having the time to enter the data manually. Moreover, the threat of bioterrorism has become the reality of a bioterrorist attack. Although the technology used to attack was quite simple, the consequences of the ensuing terror have been far reaching and profound. It has become vividly clear that attacks cannot be entirely prevented. Our best weapon then, is in the rapid collection and sharing of critical information and responding to bioterrorist attacks, a process that is entirely dependent on rapid, accurate and comprehensive data capture.
In but one application, it can be understood that healthcare in general and physician practices in particular, have not kept abreast of dramatic improvements in the technology of data capture and management. As a direct result, all stake holders from patient to providers are suffering. Technology solutions have not been adopted by the vast majority of physicians, who for the most part, function as independent small groups focused on patient interaction and patient care, and have little time or patience with high tech solutions. It is, however, quite clear that this is a fragmented market and a giant of a market waiting breathlessly for a palatable solution.
In the medical example, physicians are sometimes quoted as losing money at the rate of up to $60,000 per physician per year because of the complexity of a reimbursement system that literally forces them to choose from millions of possible coding combinations in order to get paid. Driving the revenue loss is the stern gaze of the government and the threat of monetary and even criminal penalties should physicians err on the side of over-charging for their services. Incomplete fragments of patient information are literally hidden in inaccessible paper files in hospital and physician practices around the country and tens of millions of dollars are wasted annually in trying to manage this paper nightmare. The need for a solution is staggering, and yet no one has yet solved this puzzle. Why? The answer lies in a deep understanding of physician practice mechanics and physician culture. Doctors know they have a problem and are indeed in pain. But the pain of the solutions offered have to date been greater than the pain of the existing problem.
The scope of the problem can be understood by realizing that physicians represent merely one type of service provider that is impossibly busy. In many industries, the service provider sees patients or clients non-stop from the time they arrive at their offices until the time they go home. Sixty hour weeks are the norm and their focus during that time is the patient or client; relating to the patient or client, evaluating the patient or client, determining the patient""s or client""s problems, offering a possible solution, implementing a plan, and explaining this plan with reassurance to the patient or client. In short, the practice of medicine as many other services is very much a relational, interpretive and interpersonal affair. The art of medicine is at least as important as the science which is applied. After each emotionally demanding and intellectually challenging encounter, the physician then must document his thoughts, impression and plan, and justify his reasoning in a legal document. With more patients stacking up to be seen, there is precious little time to accomplish this task, so the vast majority of physicians must dictate the results of the encounter, often very rapidly, with no time left to edit or review before the next patient encounter. Physicians do not, will not, cannot learn new methods of data entry that are less flexible and more time consuming. This is why today, less than 5% use any sort of electronic medical record. Keyboards, pen charts and inaccurate, unedited voice recognition programs cannot serve their needs and so they rely on an existing transcription system and somewhat haphazard coding solution to help them document and justify each encounter. Physicians are willing to pay for this service and pay well to relieve them of the burden of learning a new career, i.e., documentation and coding. They are people oriented, not technology oriented and can and will pay to have someone else manage this aspect of healthcare. Many have mistakenly assumed that if they build a data repository and provide the physicians with a screen and keyboard or a drop list and pen chart, that physicians will flock to them in droves. Many such technologically advanced solutions exist now, and in large part they have been ignored or quickly abandoned. The threshold of entry is simply too great.
The provider will require service as part of the data capture solution. Technology alone is not enough. Furthermore, doctors as well as others often want local service. Someone they or their staff can personally call and hold accountable. Someone who does not hide behind the veil of bureaucracy, but who is available and at risk in the relationship. In the medical application, today, the local medical transcriptionist fills that roll for creating edited paper documents. Mirroring the healthcare industry, medical transcriptionists are also typically small, fragmented, but local accountable shops which serve physician needs. They too, have a need. They realize that eventually technology will replace them, and yet they don""t know when. They realize that their clients, the doctors, needs are only partially served by the paper documents that they, the transcriptionist provide. Their very careers are at stake, but because they are small and fragmented, they do not have the individual resources to solve doctor""s problems alone. Likewise, coding solutions are many, varied and fragmented and likewise, though they are aware of physician suffering; professional coders don""t have the insight or resources to comprehensively address the need.
In the context of sharing information, one of the problems appears to be the fact that healthcare in general and physician practices in particular have not kept abreast of dramatic improvements in the technology of data capture and management. The primary disconnect in our public health surveillance system remains the archaic system of data sharing between and among public health facilities, and as importantly between the public health system and private practicing physician as well as the private system of hospitals and clinics. In September, 1999, the Senate Appropriations Committee requested, and subsequently received a status report on public health""s infrastructure. One of the primary needs identified in this document is the need for robust information and data systems. As a result of that report, the Health Alert Network became a key priority of both the Centers for Disease Control, and the Secretary of the Department of Health and Human Services. The HAN was designed to meet the goals and recommendations set by the status report. One of three primary goals identified is as follows:
xe2x80x9cGoal number 2, robust information and data systems GOAL: Each health department will be able to electronically access and distribute up-to-date public health information and emergency health alerts, monitoring the health of communities, and assist in the detection of an emerging public health problem.
Recommendation 5: By 2010, ensure that all health departments have continuous high speed access to the internet and standard protocols for data collection, transport, electronic reporting and information exchange that protects privacy and seamlessly connect local, state, and federal data systems.
Recommendation 6: By 2010, ensure that all health departments have immediate online access to current public health recommendations, health and medical data, treatment guidelines and information on the effectiveness of public health interventions.
Recommendation 7: By 2010, ensure that all health departments have the capacity to send and receive sensitive health information via secure electronic systems and to broadcast emergency health alerts among hospitals, medical centers, universities, and local public health systems and agencies.xe2x80x9d
As to the medical application, clearly, these goals must be achieved to successfully leverage currently available technology and protect the public health. The events of September 2001 however, make it equally clear that a fragmented state-by-state approach may get us there by 2010, but we no longer enjoy the luxury of time. There is now an immediate and tangible threat that must be addressed in months, not years. Furthermore, a key component in the electronic chain has not been adequately addressed by these important recommendations or by the health alert network. Namely, successful, accurate data capture by providers in the field, both public and private. Unfortunately, technology solutions have not been adopted by the vast majority of physicians who, for the most part, function independently. They are focused on patient interaction and patient care, and keeping abreast of the rapid evolution of medical knowledge and have had little time or patience for high tech solutions. As a result, incomplete fragments of patient information are buried in inaccessible paper files in hospital and physician practices around the country. Not only are tens of millions of dollars wasted in trying to manage this paper nightmare, but literally billions of dollars are lost due to our inability to capture the data and glean critical information on public health, treatment efficacy and the early detection of health trends so that effective and rapid solutions can be deployed. If the information cannot be captured, it cannot be managed. If it cannot be managed, then care cannot be optimally improved. This simple logic has profound implications for responsiveness to bioterrorist threats as well as the overall public health and safety.
Conceptually, the invention can be presented and understood from a variety of perspectives. With the understanding that such details are not limiting, from one perspective it can be understood by reference to four device-oriented aspects: a CE or other personal computing capability recorder object, a functionality for precision coding through software and applications or the like, a separate CE or other personal computing capability such as an active-synch docking portal station, and even file transfer protocols such as, in a medical application for example, a health insurance portability and accountability act (HIPAA) compliant electronic signature aspect. Each of these aspects can of course be presented and used separately or they may be combined with any combination or permutation of these or other aspects to present an overall system.
From a data creation perspective, the invention can be understood as potentially encompassing a data tagging engine or other functionality, perhaps or even functionality for parsing text to data, an application for dealing with a workflow digital stream such as in one application for a medical transcriptionist or other such user, and a HIPAA compliant electronic note security transfer system. Again, each of these aspects can of course be presented and used separately or they may be combined with any combination or permutation of these or other aspects to present an overall system.
In addition, the invention can also be understood from an information flow or access perspective by reference to a digital stream, an Internet or other access database, an automated patient information services, and an interactive portal-based knowledge delivery system. One more, each of these aspects can of course be presented and used separately or they may be combined with any combination or permutation of these or other aspects to present an overall system.
One task in solving the problem is in simply capturing the data. The invention includes elements designed to tap into the vast amount of data and information that every moment in every office in America is dictated into a hand held portable tape recorder. The invention can many the two concepts of coding and a checklist by placing the custom templates directly on the screen of a hand held device such as a pocket PC. The invention can permit dictation directly xe2x80x9cintoxe2x80x9d a pre-chosen template on a pocket PC, thus creating a digital.wav or other file of structured data that is then sent to a secure site such as via the Internet. An existing network of local independent transcriptionists can be leveraged (in many cases it may be the medical transcriptionist the doctor is already using) to access that structured data via the web and plug it into templated data fields as he or she is transcribing or editing the note. Surprisingly this can be accomplished simply and seamlessly. To the transcriptionist, it is an opportunity to provide a solution to their clients and save their careers doing much the same work they have always done, but they no longer need to drive to the site of practice, pick up tapes and because the technology can interface seamlessly with existing practice management software; they also no longer face the nightmare of matching demographic information to dictated tapes. Now the data (coding, for example) can be shaped, captured, and structured in one seamless process that leverages existing networks and does so without increasing cost to the physician or decreasing compensation to the transcriptionist. In fact, the technology can be further leveraged to save the physician or other person substantial time (through the use of customized macros), money (through more accurate coding) and to relieve the burden of fragmented, inaccessible patient data by collecting the information in a secure site accessible from any Internet portal. Further, using an XML model and leveraging semi-automation, the invention can allow an interface with existing systems. In one embodiment, wireless, portable remote hand held units can function as two-way data and information portals.
The hand held data entry device can be used to record pertinent data of any kind such as disease surveillance data, ICD-9 or CPT coding information, physical examination, history or lab data. Because the system is portable and voice driven, and because the data can be shaped and structured with templates and checklists, there is optimum flexibility and a very flat learning curve (i.e., as easy as dictating into a tape recorder with a checklist at your fingertips) and therefore, should have high adoption rates. The data can also be securely stored in a central database in XML format where it can be aggregated and then queried to serve a variety of needs. Further, the template model can allow any entity to create custom templates and checklists downloaded from the web to shape data entry such that specific critical data elements can be captured and tagged. In addition, the solution can work both ways. Not only can customized templates be deployed via the Internet to all hand held data entry devices, but they can also receive health alerts, updates and pertinent templates immediately in real time, dramatically shortening the information cycle in both directions. Remote systems with radio wireless technology can be used to keep remote sites connected to the central data processing repository and the health alert network in real time.